Taking $2.5M a year out of prior-auth intake.
A large member-owned U.S. health insurer replaced an outsourced, per-page intake operation with automated processing that validates prior-authorization packets and routes them into the systems it already uses.
Figures are based on the customer’s own pre- and post-deployment measurements.
The cost stopped rising with volume. Once intake moved off per-page outsourcing to automated processing, growing fax volume no longer meant a proportionally larger bill.
The prior-auth intake process was slow and costly.
Nearly 300,000 prior-authorization faxes arrived every month, almost 70 million pages a year, and every one had to be validated, indexed, and routed into the right system before a clinician could begin. That work was outsourced, priced per document and per page, and it added up to more than $7M a year.
Costs rose with volume. Per-unit pricing meant the invoice grew at the same rate fax volume grew.
Turnaround slipped. Manual processing slowed authorizations, because clinical review waited on indexing.
Manual entry created avoidable risk. Errors could carry into review, with no standardized audit trail.
More volume meant more people. The operation could only add capacity by adding staff.
What changed: automated intake in front of clinical review.
Every packet is processed as it arrives.
Each packet is handled as soon as it arrives. Requests arriving by fax, email, or portal come into one queue. Documents are classified and separated, and the required information, including member, provider, procedure codes, dates, and other fields, is extracted and checked against the plan’s business rules. Anything that does not meet the required confidence level goes to a person for review. Cleared records are written directly into the systems the plan already uses.
Automation was introduced in stages. By six months, 70% of intake was running straight through. Anything below the confidence threshold still went to a person, and every step from receipt to the indexed record was logged.
Why it still matters as prior-auth requirements shrink.
The original economics were straightforward: outsourced intake was priced by document and page, so costs increased with volume. Automation changed that. The plan could process substantially more work without its intake cost rising at the same rate.
Payers are now removing authorization requirements for more routine services. That leaves fewer requests requiring clinical review, but the requests that remain tend to involve more exceptions, documentation, and clinical complexity.
For those cases, the job is different. Get a complete request to the right reviewer quickly, and send exceptions to people when something needs attention.
What is your prior-auth intake costing you today?
Give us 45 minutes and a sample of your own packets. We will show you where the time goes, where errors occur, and what the intake process is costing you.